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The PMRExam Podcast

PMR Board Prep instructor and PMRExam's creator, David Rosenblum, MD discusses issues relevant to Physiatrists and Pain Physicians. Dr. Rosenblum's Physical Medicine and Rehabilitation Podcast, The PMRExam Podcast, features, interviews, board prep and practice management issues relevant to rehab physicians. For more information on Physiatry board prep and CME credits, go to PMRExam.com
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Now displaying: Category: physical medicine and rehabilitation
Apr 3, 2024

Advocating for Transparency and Oversight in Pain Management

Introduction:

  • Welcome back to Painexam, where we delve into the latest advancements and challenges in pain management.
  • Today's episode highlights a significant advocacy effort made by leading Interventional Pain Physicians and industry experts.

Summary of Lobbying Effort:

  • On March 20, 2024, a group of widely known and respected pain physicians and industry leaders, including Drs. Sean Li, Peter Staats, Mehul J. Desai, David Reece, Hemant Kalia, and David Rosenblum, alongside industry figures Mark Stultz, Christopher Conrad, and Cecelia Ruble, visited Capitol Hill to advocate for greater oversight and transparency in independent review organizations.
  • Despite their busy schedules, they recognized the critical need to address the 0% turnover rate in appeals for denied treatments, which disproportionately affects patients seeking alternatives to surgery and opioid medication.

Importance of Transparency:

  • The issue extends beyond pain management, impacting patients across various medical fields.
  • While opioid therapy may seem economically favorable initially, the long-term consequences, including delayed care and medication side effects, often outweigh the costs.
  • The group emphasized the importance of an unbiased review for  accessible, cutting-edge treatments to improve patient outcomes and reduce overall healthcare expenses.

Purpose of the Lobbying Effort:
Contrary to pushing any specific company agenda, the initiative aims to highlight the challenges patients and physicians encounter in securing optimal treatment outcomes.

 

For Board Prep, Ultrasound Training and more, visit:

Dr. David Rosenblum, a pioneer in interventional pain medicine, particularly in ultrasound-

guided procedures and regenerative pain medicine, underscores the necessity of addressing these issues for the benefit of countless patients suffering from chronic pain.

Conclusion and Actionable Steps:

  • To schedule a consultation with Dr. Rosenblum, patients can visit www.AABPpain.com or contact the Brooklyn Office at 718-436-7246 or the Garden City Office at 516-482-7246.
  • Stay tuned for more updates on advancements and advocacy efforts in pain management.

Outro:

  • Thank you for joining us on this episode of Painexam. Be sure to subscribe for future discussions on navigating the complexities of pain management.
Feb 28, 2024

Dr. Rosenblum interviews West Viriginia Society of Interventional Pain Physician's President Rudy Malayil, MD and discusses the upcoming WVSIPP meeting in April 2024 as well as Dr. Rosenblum's upcoming ultrasound course. 

Rudy Mathew Malayil, M.D., completed his internship in General Surgery at New York Presbyterian/Cornell Hospital in New York City, followed by residency training in Physical Medicine and Rehabilitation at New York University Medical School. Dr. Malayil further completed a Pain Medicine Fellowship at the Albert Einstein School of Medicine at the Beth Israel Medical Center Campus in New York City. 

After training he went settled in West Virginia and eventually became the president of West Virginia Society of Interventional Pain Physicians and started private practice Pain Management 360.

 
Ultrasound Interventional Pain Course Registration 
 
 
For Anesthesia Board Prep Click Here!
 
References
https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1293358/full
Feb 8, 2024

In this episode, Garden City (long island) based Pain Physician, Dr. David Rosenblum explores Peripheral Nerve Stimulation, Biologics and Ablations for hip pain.

He reviews a case report of a 67-year-old female with a history of a mechanical fall causing injury to her lumbar spine and pelvis resulting in hip and pelvic pain is presented. The patient had hypertrophic non-union of the right iliac wing fracture and displacement of the pubic symphysis and right sacroiliac joint. Medications were not effectively managing her pain, so she sought treatment at a pain management clinic.

The patient underwent diagnostic obturator and femoral articular nerve branch injections, as well as a middle cluneal nerve steroid injection, all guided by fluoroscopy and ultrasound. She experienced improvement in her pain following these procedures. Subsequently, she had a peripheral nerve stimulator (PNS) trial and underwent implantation of leads targeting the right middle cluneal nerve and right obturator and femoral articular nerve branches.

The patient reported significant relief in both the posterior and anterior distribution of her pain. Her activities of daily living improved, and she was able to sleep without pain after the PNS implantation. The successful use of combined fluoroscopy and ultrasound in targeting the specific nerves and replicating the patient's pain distribution before permanent PNS implantation is highlighted in this case.

Additionally, the show notes mention an events calendar located at this link: https://www.nrappain.org/pages/ultrasound-course-calendar.

Upcoming Course schedule for NRAP Academy includes the following events:

  1. Ultrasound Guided Pain & Regional Anesthesia Course in New York City on February 10, 2024. This course will cover nerve blocks, joint injections, and more. Attendees will have the opportunity to scan live models after the didactic session.

  2. MSK Pain & Regional Anesthesia Course in Miami, Florida on February 18, 2024. This course will focus on ultrasound-guided nerve blocks and MSK (musculoskeletal) pain management.

  3. Ultrasound Guided Pain Course in Key West, Florida on February 23, 2024. This 4 CME (Continuing Medical Education) course will cover ultrasound-guided nerve blocks, MSK, PRP (platelet-rich plasma), BMAC (bone marrow aspirate concentrate) targets, and regional anesthesia.

  4. Regional Anesthesia and US Guided Pain Management Course in New York City on March 9, 2024. This course will provide training in ultrasound-guided interventional pain management and regional anesthesia.

  5. Ultrasound Guided IPM (Interventional Pain Management) Course in West Virginia on April 14, 2024. This course is part of the Appalachian Regional Spine and Pain Meeting and will be conducted by NRAP Academy. It will focus on interventional pain management using ultrasound guidance.

  6. Regenerative Pain Medicine Course in New York City on May 4, 2024. This course will cover PRP (platelet-rich plasma) and other regenerative pain medicine techniques.

In addition to the live training, attendees will receive bonus material including access to the On Demand Ultrasound Guided MSK Interventional Pain Management Course, a course workbook and certificate, post-course guidance and discounts, and the opportunity to join the mailing list for calendar updates.

Please note that these course details are subject to change, so it's recommended to visit the NRAP Academy website for the most up-to-date information.

Reference

Fu E, Elsharkawy H
#35977 Peripheral nerve stimulation implant for chronic post-traumatic hip and pelvic pain
Jan 24, 2024

Painexam Podcast Show Notes: Journal Club on "Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves"

Special Thanks to Robert Stall, MD

Introduction:

  • Welcome to another episode of the Painexam Podcast! In today's journal club edition, we delve into a fascinating study by Dr. Joel E. Pessa on cerebrospinal fluid (CSF) circulation in human nerves.

Background:

  • The study addresses the growing evidence of CSF circulation in human nerves and its implications in various conditions encountered by plastic surgeons.
  • Conditions such as nerve transection, stretch injuries, and peripheral neuropathy may be related to dysregulation of the CSF system.

Methods:

  • Dr. Pessa and his team developed the ventricular infusion technique using buffered saline in 2017.
  • The technique was applied to eight fresh cadavers before dissecting the median nerve.
  • Fluorescent imaging and nanoprobe injections were combined with ventricular infusion in selected specimens.

Results:

  • The eight cadaver specimens (six female, two male) aged 46–97 underwent successful ventricular infusion.
  • Ventricular cannulation was performed successfully using specific coordinates.
  • Results suggest that CSF flows in neural sheaths, including pia meninges, epineurial channels, perineurium, and myelin sheaths (neurolemma).

Conclusions:

  • Ventricular infusion and nanoprobes effectively identify CSF flow in neural sheaths of human nerves.
  • CSF flow in nerves is described as an open circulatory system occurring via channels, intracellular flow, and cell-to-cell transport associated with glial cells.
  • Neural sheaths, including neurolemma, may play a role in glucose and solute transport to axons.
  • The techniques showcased in this study can be utilized in anatomic dissection and live animal models and have been extended to the central nervous system to identify direct ventricle-to-pia meninges CSF pathways.

Significance:

  • This study opens new avenues for understanding the intricate mechanisms of CSF circulation in neural tissues.
  • Plastic surgeons and researchers can benefit from these techniques in studying and addressing conditions related to CSF dysregulation in nerves.
  • The findings have implications not only for nerve-related conditions but also for broader applications in the central nervous system.

Closing:

  • Thank you for joining us on this insightful journey through Dr. Joel E. Pessa's study. Stay tuned for more engaging discussions on pain management and neurology in future Painexam Podcast episodes!

Reference

Pessa JE. Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves. Plast Reconstr Surg Glob Open. 2022 Feb 17;10(2):e4126. doi: 10.1097/GOX.0000000000004126. PMID: 35198353; PMCID: PMC8856590.

Jan 10, 2024

 

Exploring the Role of Ultrasound in Headache Evaluation and Treatment

A Journal Club based on Dr. Andrea Trescott's article: 

 Ultrasound for evaluation and treatment of headaches. Anaesth Pain & Intensive Care 2017;21(2):241-253.

Click Here to Claim CME for reflecting on content presented in this journal club.

David Rosenblum, MD

Accepting New Patients

Patients Interested in scheduling a consultation with Dr. David Rosenblum can call 

516 482 7246 (Garden City) or 718 436 7246 (Brooklyn)

In this Podcast, Dr. Rosenblum discusses patient's in his practice who responsed to ultrasound guided nerve blocks in the treatment of headaches.  He discusses the use of ultrasound injections as opposed to medication to manage the pain and references Dr. Trescott's comprehensive article on the various nerves and clinical presentations of headaches related to terminal nerve entrapment or irritation. 

Dr. Rosenblum discusses

  • Supraorbital Neuralgia
  • Auriculotemproal Nerve
  • Anatomy
  • Clinical presentation
  • Interventional Pain Therapies

Summary of Dr. Trescott's Article and Key Points:

  • Headaches, affecting 28 million people in the US, pose a significant burden on society in terms of medical costs and lost labor. They are complex neurologic disorders with diverse origins and causes.
  • Headaches are often viewed as the primary pathology, but they are fundamentally a symptom. Understanding them is an evolving science, and their patterns can be recognized for effective diagnosis and treatment.
  • In 2003, Pareja et al proposed the term "epicrania" for headaches triggered by extracranial causes, suggesting a link between intracranial components and extracranial nerves.

Peripheral Triggers and Plastic Surgery:

  • Plastic surgeons noted relief of migraines through corrugator muscle resection and botulinum toxin injection, indicating peripheral headache triggers.
  • Severe migraines post-head or neck injury may have an extracranial origin, suggesting peripheral nerve irritation. Traditional migraine medications may offer modest relief.
  • Primary treatment involves inhibiting nerve irritation through interventional pain techniques, turning off the pain origin and associated migraine centers.

Ultrasound Advantages:

  • Evaluation and injection of nerves have traditionally used landmarks and fluoroscopic images, but ultrasound offers unique advantages.
  • Nerves often travel with arteries, potentially contributing to "throbbing" pain. Ultrasound provides a more precise and dynamic visualization of these structures.

Exploring Extracranial Causes:

  • The International Classification of Headache Disorders (ICHD) categorizes headaches as primary or secondary. While valuable, it broadly defines peripheral nerve contributions as "Other Terminal Branch Neuralgias."
  • The study of extracranial peripheral nerve entrapments and dysfunction reveals overlap between ICHD-defined headaches and potential nerve entrapments causing these pain patterns.
  • Collaboration with disciplines like pain management enriches the understanding and treatment options for headaches.

Conclusion:

  • Headaches, often seen as isolated intracranial phenomena, may have extracranial triggers. Understanding and treating these triggers, especially through ultrasound-guided techniques, present a promising avenue in headache management.

NRAP Academy also offers:

 

Private Ultrasound Training Available

Email Info@NRAPpain.org

Reference:

  • Trescot A. Ultrasound for evaluation and treatment of headaches. Anaesth Pain & Intensive Care 2017;21(2):241-253.

Publication Details:

  • Received: 15 Aug 2015, Reviewed: 2 Jun 2016, Accepted: 28 Jun 2016.

This podcast explores the dynamic relationship between intracranial and extracranial factors in headaches, shedding light on potential breakthroughs in their evaluation and treatment.

  #interventionalpain #painboards #painfellowship #painexam  #regionalanesthesia #ultrasoundguidedpain #ultrasoundpain #ultrasoundmsk   #paincme #paincmecourse

Dec 27, 2023
Phenol in the treatment of Hip Pain
 
Bonus CME Available ($15 Processing Fee)
The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/wo9gDI
 
Dr. Rosenblum discusses the use of phenol injected into the pericapsular nerve group, hip joint and outcome a isolated case reports.  Also discussed, phenol, its mechanism of action and a refractory case of neuralgia paresthetica.  Pain from hip cancer, pain from DVT and IPACK or articular branch of the tibial nerve block discussed for knee pain. 
 
Dr. Rosenblum discusses his ultrasound training programs, the migration of the PainExam platform to the new NRAPpain.org website and offers a testimonial from a previous ultrasound course from the student who inspired this podcast.
 
Patients interested in scheduling a consultation with Dr. Rosenblum can call 516 482 7246 or 718 436 7246
For our Live Course Calendar, Click here
 
 
Board Prep for PM&R, Pain and Anesthesiology Boards
 

References

Monagle, John; Ee, Joanne1. Treatment of chronic hip osteoarthritic pain with intra-articular phenol. Indian Journal of Pain 27(1):p 41-43, Jan–Apr 2013. | DOI: 10.4103/0970-5333.114866 
Marcio V. Pimenta, Amanda T. Nakamura, Hazem A. Ashmawi, Joaquim E. Vieira, Hermann dos Santos Fernandes,
Ultrasound-guided pericapsular nerve group and obturator nerve phenol neurolysis for refractory inpatient hip cancer metastasis pain: a case report,
Brazilian Journal of Anesthesiology (English Edition),
2021,
Rocha Romero, A., Carvajal Valdy, G. & Lemus, A.J. Ultrasound-guided pericapsular nerve group (PENG) hip joint phenol neurolysis for palliative pain. Can J Anesth/J Can Anesth 66, 1270–1271 (2019). https://doi.org/10.1007/s12630-019-01448-y
Sep 28, 2023

Dr. Rosenblum discusses his concerns over:

 RFA of the Genicular Nerves being a non reimbursed service when the patient already had them in the past with excellent relief.

Plus a discussion on CMS policy toward Peripheral Nerve Block reimbursement limitations and documentation!

Pain Management, Anesthesiology, PMR Board Review

Upcoming Workshops and Events

 

NYC Regional Anesthesia and  Pain  Ultrasound CME  Workshop

Saturday, October 28, 2023 8:00 AM

 

Charleston, SC  Regional Anesthesia and  Pain  Ultrasound CME  Workshop

Sunday, October 29, 2023 9:00 AM

 

NRAP Academy:  Regenerative Pain Medicine Course NYC

Saturday, November 11, 2023 8:00 AM

 

NYC Regional Anesthesia and  Pain  Ultrasound CME  Workshop

Saturday, December 16, 2023 7:30 AM

 

NYC Regional Anesthesia and  Pain  Ultrasound CME  Workshop

Saturday, January 6, 2024 7:30 AM

 

For  up to date Calendar, Click Here!

Reference

 

Sep 26, 2023

The 2024 Physician Fee Schedule and Remote Patient Care with Rachel Trobman, CEO of Upside Health.

Dr. Rosenblum and Rachel Trobman cover topics ranging from Remote Patient Care coding, acronyms, implementation, reimbursement and much more!

physician fee schedule 2024 and remote patient care, an interview with Rachel Trobman of Upside Health

Upcoming Workshops and Events

ASPN Webinar: Continuing Eduction and Board Prep October 4, 2023 8PM

Maximizing Profit: Understanding the 2024 Physician Fee Schedule

Wednesday, September 20, 2023 8:00 PM

NYC Regional Anesthesia and  Pain  Ultrasound CME  Workshop

Saturday, October 28, 2023 8:00 AM

Charleston, SC  Regional Anesthesia and  Pain  Ultrasound CME  Workshop

Sunday, October 29, 2023 9:00 AM

NRAP Academy:  Regenerative Pain Medicine Course NYC

Saturday, November 11, 2023 8:00 AM

NYC Regional Anesthesia and  Pain  Ultrasound CME  Workshop

Saturday, December 16, 2023 7:30 AM

NYC Regional Anesthesia and  Pain  Ultrasound CME  Workshop

Saturday, January 6, 2024 7:30 AM

 

Aug 24, 2023

Dr. Rosenblum discusses posterior hip pain/buttock pain near scar after Total Hip Arthroplasty. Included in this episode:

  • Patient Testimonial re: SPRINT PNS (superior gluteal and superior cluneal nerve)
  • Superior Gluteal Nerve Anatomy
  • Hip Innervation
  • Upcoming Private and Group Ultrasound Training

Upcoming Pain Management Conferences

 

Course Calendar

2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

Oct. 28 Regional Anesthesia and Interventional Pain Medicine NYC

Nov.11 Regenerative Pain Medicine Course: NYC  

Dec. 16th Regional Anesthesia and Interventional Pain Ultrasound Training NYC

2024

Jan. 6 Regional Anesthesia and Interventional Pain Ultrasound Training NYC

For  up to date Calendar, Click Here!

References

Pierre Laumonerie and others, Sensory Innervation of the Hip Joint and Referred Pain: A Systematic Review of the Literature, Pain Medicine, Volume 22, Issue 5, May 2021, Pages 1149–1157, https://doi.org/10.1093/pm/pnab061

Pinho, A.R.; Leite, M.J.; Lixa, J.; Silva, M.R.; Vieira, P.; Nery-Monterroso, J.; Bezerra, M.C.; Alves, H.; Madeira, M.D.; Pereira, P.A. Superior Gluteal Nerve Anatomy and Its Injuries: Aiming for a More Secure Surgical Approach of the Pelvic Region. Diagnostics 2023, 13, 2314. https://doi.org/10.3390/diagnostics13142314

Lung K, Lui F. Anatomy, Abdomen and Pelvis: Superior Gluteal Nerve. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535408/

Aug 12, 2023

David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy’s Continuing Medical Education Programs, discusses: a case of paresthesia in the upper neck realted to C3 and C4 stenosis and considers a selective nerve root block while wondering if a deep cervical plexus block would suffice.  

Rational :

  • Desire to avoid epidural due to proximity to spinal cord
  • Ultrasound approach of cervial plexus may anesthetize C3 and C4 roots and may be sufficient to do with ultrasound alone
  • Unfortunately, no data found to support this particular situation, however, it may be safe and effective if performed properly.   

Claim CME

The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/lubWXJ

Also discussed on this podcast:

The Superficial Cervical Plexus and applications for headache, neck pain, and clavicular fractures. 

Caution: Phrenic Nerve

Anatomy

The cervical plexus is a complex network of nerves located in the neck region, originating from the anterior rami (branches) of the cervical spinal nerves, specifically those stemming from the upper cervical segments (C1 to C4). This intricate network serves to provide sensory and motor innervation to various structures within the neck and surrounding areas.

The cervical plexus is positioned within a groove between the longus capitis and the middle scalene muscles in the neck. It is organized into different nerve loops and branches that radiate outwards to supply various regions. The cervical plexus can be divided into deep and superficial components, each with distinct functions and innervation patterns.

Cervical Plexus: The plexus involves nerve loops and branches that provide both sensory and motor functions. The superficial sensory branches originating from adjacent anterior spinal nerves (C2 to C4) are responsible for providing sensation to specific areas of the skin, particularly in the head, neck, and shoulder regions. These sensory branches include the lesser occipital nerve (C2, C3), great auricular nerve (C2, C3), transverse cervical nerve (C2, C3), and supraclavicular nerves (C3, C4). These nerves typically run posteriorly and then penetrate the prevertebral fascia before reaching the skin and superficial structures.

For Pain Management and Anesethesiology Board Review, go to

For the Virtual Pain Fellowship Experience, Go to:

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Ultrasound Workshops and Courses

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

Regenerative Pain Medicine Course NYC- November 11, 2023

For  up to date Calendar, Click Here!

Refereces

Kim JS, Ko JS, Bang S, Kim H, Lee SY. Cervical plexus block. Korean J Anesthesiol. 2018 Aug;71(4):274-288. doi: 10.4097/kja.d.18.00143. Epub 2018 Jul 4. PMID: 29969890; PMCID: PMC6078883. Read more!

Aug 3, 2023

ISPN Dubai 2023

David Rosenblum, MD interviews Reda Tolba, MD on the PainExam Podcast

In this episode, we delve into the realm of Pain Management in the US and the Middle East. Our international pain experts discuss the upcoming ISPN (International Society for Pain and Neuroscience) meeting in Dubai this december.

ISPN Pain Dubai Conference

 

Subscribe to the PainExam Newsletter to Receive Free Content, Discounts and Course Updates!

 

Dr. Reda Tolba, MD, chairs the Pain Management Department at Cleveland Clinic Abu Dhabi. He's internationally recognized for his contributions to Pain Medicine, boasting a wealth of experience from institutions like Wake Forest University Medical Center and Ochsner Health System.

Dr. David Rosenblum, MD, is the Director of Pain Management at Maimonides Medical Center and a driving force behind pain education platforms like PainExam.com and NRAP Academy. He's a pioneer in ultrasound-guided pain procedures, having trained thousands of physicians online and in person.

PainExam Pain Management Board Review

Tune in to hear Dr. Tolba's journey to being named Chair of Pain at Cleveland Clinic, Abu Dhabi, and his impressive academic and clinical achievements.Dr. Rosenblum, on the other hand, is known through his contributions to safe pain management protocols, and his mission to spread knowledge through podcasts and educational events.

AABP Integrative Pain Care's Dr. David Rosenblum in Garden City and LI

Patients, interested he's scheduling an appointment with Dr. Rosenblum at his Long Island or Brooklyn Locations can go to AABPpain.com or call 718 436 7246 or 516 482 7246

To learn more about their work and educational initiatives, explore NRAPpain.org and PainExam.com/events. Join us in this episode to uncover insights from these leading figures in Pain Management.

Ultrasound Training

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

For  up to date Calendar, Click Here!

Jul 11, 2023

On this episode, Dr. Rosenblum has a chat with Premier Heritage's Greg Alerte.

Greg has over 15 years of experience helping families and small business to achieve their financial goals. As co-owner and Certified Financial Planner at Premier Heritage, he focuses on helping people to preserve and grow their wealth, and to leave a legacy for future generations to build on. Greg’s research and professional opinions, have been quoted in several financial publications, including Wall Street Journal, NerdWallet, Financial Planning magazine, and the Huffington Post. Greg’s favorite quote is by the late Mia Angelou “when you learn teach, when you get give”

For more information, Email: galerte@premier-heritage.com

David Rosenblum, MD

David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy’s Continuing Medical Education Programs, discusses:

Attend and NRAP Course!

NRAP Academy's Regional Anesthesia Course

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

For  up to date Calendar, Click Here!

 

Jun 29, 2023

 

David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy’s Continuing Medical Education Programs discusses Central post-stroke pain (CPSP).

 

Central Post Stroke Pain is a debilitating condition that affects a significant number of stroke survivors. It is characterized by persistent neuropathic pain, often described as burning, shooting, or electric shock-like sensations, in the areas of the body affected by the stroke. CPSP can significantly impact a patient's quality of life and functional recovery, making it crucial for physicians to have a comprehensive understanding of its pathophysiology.

Earn CME Credit

The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/HQ69sg

Ultrasound Workshops and Courses

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

For  up to date Calendar, Click Here!

Neuropathic Pain and Central Sensitization:CPSP is classified as a neuropathic pain syndrome, which means it arises from a dysfunction or damage to the nervous system. The exact pathophysiology of CPSP is complex and multifactorial, but it often involves the phenomenon of central sensitization. Central sensitization refers to the increased excitability and responsiveness of neurons within the central nervous system (CNS) in response to peripheral input.

Cortical Reorganization and Plasticity:

One key aspect of CPSP pathophysiology is cortical reorganization and plasticity. Following a stroke, the brain undergoes structural and functional changes as a result of the injury. This neuroplasticity, particularly in the somatosensory cortex, can contribute to the development of CPSP. Maladaptive plasticity may occur, leading to abnormal sensory processing and the generation of pain signals in response to non-painful stimuli.

Disrupted Pain Modulation Pathways:The pain perception and modulation pathways in the CNS play a crucial role in regulating pain signals. In CPSP, these pathways can be disrupted, leading to abnormal pain processing. Alterations in the descending inhibitory pathways, such as reduced inhibitory neurotransmitter release or impaired endogenous opioid system function, can result in increased pain sensitivity and the persistence of pain signals even after the resolution of the initial injury.

Inflammatory Processes and Neurotransmitter Imbalances:Inflammation within the CNS and imbalances in neurotransmitter systems also contribute to CPSP. Following a stroke, there is an inflammatory response that involves the release of pro-inflammatory cytokines and activation of immune cells. This inflammation can lead to sensitization of nociceptive neurons and exacerbate pain signaling. Additionally, imbalances in neurotransmitters, such as glutamate, serotonin, and norepinephrine, may disrupt the normal pain processing pathways, further amplifying pain perception.

Peripheral and Central Lesions:CPSP can arise from both peripheral and central lesions. Peripheral lesions, such as damage to the spinothalamic tract or thalamus, can directly affect the transmission of pain signals. Central lesions, on the other hand, involve damage to the somatosensory cortex, thalamus, or other brain regions involved in pain processing. Both types of lesions can contribute to the development of CPSP through various mechanisms, including altered neuronal activity, disrupted connectivity, and aberrant sensory processing.

 The complex interplay of cortical reorganization, disrupted pain modulation pathways, inflammatory processes, and peripheral and central lesions contribute to the development and persistence of CPSP. Further research is needed to unravel the intricacies of CPSP's pathophysiology, leading to the development of targeted therapies to alleviate the burden of this debilitating condition.

References

Liampas, A., Velidakis, N., Georgiou, T. et al. Prevalence and Management Challenges in Central Post-Stroke Neuropathic Pain: A Systematic Review and Meta-analysis. Adv Ther 37, 3278–3291 (2020). https://doi.org/10.1007/s12325-020-01388-w

SYSTEMATIC REVIEW article Front. Neurol., 18 August 2021Sec. Stroke
Volume 12 - 2021 | https://doi.org/10.3389/fneur.2021.678198

Jun 21, 2023

David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy’s Continuing Medical Education Programs, discusses:

  • Genicular Nerve Ablation with Phenol
  • The history of phenol
  • The mechanism of action
  • Indications
  • Complications
  • Clinical concerns when considering neurolysis with phenol
 
Claim CME Credit
The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/9GkVWu
References
D'Souza RS, Warner NS. Phenol Nerve Block. [Updated 2023 Jan 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. 
 
 Risso CR e tal.Chemical Ablation of Genicular Nerve with Phenol for Pain Relief in Patients with Knee Osteoarthritis: A Prospective StudyVolume21Issue4April 2021Pages 438-444
May 23, 2023

Long Island and Brooklyn based Pain Physician, David Rosenblum, MD describes prolotherapy and discusses mechanism of action, evidence and protocols.  Also mentioned in this podcast, Prolotherapy protocols, low dose version high dose dextrose prolotherapy, spine prolotherapy, Spine ligaments Intertransverse ligament, Ilolumbar ligament pain and more!

The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/IjV2JT

For Pain Management Board Review go to

 

References

Geonhyeong Bae, Suyeon Kim, Sangseok Lee, Woo Yong Lee, Yunhee Lim. Prolotherapy for the patients with chronic musculoskeletal pain: systematic review and meta-analysis Anesth Pain Med 2021;16(1):81-95.

Solmaz, İ. & Örsçelik, A. (2022). Approximately Three Years of Prolotherapy Experience of a Traditional and Complementary Medicine Center: An Epidemiologic Study . International Journal of Traditional and Complementary Medicine Research , 3 (2) , 64-70 . DOI: 10.53811/ijtcmr.1040648
 
Harmon, Dominic, and Vladimir Alexiev. "Sonoanatomy and injection technique of the iliolumbar ligament." Pain Physician 14.5 (2011): 469.
 
David Rosenblum, MD
 
Sit, R.W.S., Wu, R.W.K., Reeves, K.D. et al. Efficacy of intra-articular hypertonic dextrose prolotherapy versus normal saline for knee osteoarthritis: a protocol for a triple-blinded randomized controlled trial. BMC Complement Altern Med 18, 157 (2018). https://doi.org/10.1186/s12906-018-2226-5
May 10, 2023

Morton’s Neuroma Diagnosis Treatment and Regenerative Medicine Options

 
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Dr Rosenblum discusses Morton’s Neuroma and describes typical presentation, diagnosis, treatments such as corticosteroid injection, nerve ablation, regenerative medicine and more!
 
 
Morton's neuroma is a painful condition that affects the foot, specifically the ball of the foot. It occurs when the tissue surrounding the nerves leading to the toes thickens, causing intense pain, numbness, or a burning sensation.
 

Course Calendar

 

Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain!

Regenerative Pain Medicine Course NYC- May 13

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

For  up to date Calendar, Click Here!

References
 
Platelet-rich-plasma Injection Therapy For Morton's Neuroma - Page #4. https://www.amssm.org/plateletrichplasma_injecti-csa-268.html?StartPos=130&Part=4a

Bhatia M, Thomson L. Morton's neuroma - Current concepts review. J Clin Orthop Trauma. 2020 May-Jun;11(3):406-409. doi: 10.1016/j.jcot.2020.03.024. Epub 2020 Apr 10. PMID: 32405199; PMCID: PMC7211826.

Barbara De AngelisLucilla LucariniFabrizio OrlandiAnnarita AgovinoAlessia MignerValerio CervelliValentina IzzoCristiano CurcioRegenerative surgery of the complications with Morton's neuroma surgery: use of platelet rich plasma and hyaluronic acidVolume10Issue4 August 2013 Pages 372-376
Apr 27, 2023

Join digital health leader and Upside Health CEO Rachel Trobman and PainExam.com founder Dr. David Rosenblum in a conversation about the impact of the end of the public health emergency in May could have on your pain management practice. We'll specifically discuss the changes to telehealth and remote patient monitoring. The webinar will close with one of Upside Health's clients outlining the launch and successes of RTM in their practice and be available for Q&A.

Course Calendar

 

Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain!

Regenerative Pain Medicine Course NYC- May 13

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

For  up to date Calendar, Click Here!

 

For more questions Email Rachel Trobman at Rachel@upside.health

Mar 11, 2023
Knee Osteoarthritis and Regenerative Pain Medicine
 
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The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/TJXGw0
 
 
Dr. Rosenblum reviews the latest evidence comparing Bone Marrow Aspirate and Platelet Rich Plasma for knee pain. He also reviews the latest publication by Di Martino et al’s study which compared Leukocyte-rich PRP vs. Leukocyte-poor PRP in the treatment of knee osteoarthritis. 
 
Upcoming Courses

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023 

Regenerative Pain Medicine Course NYC- May 13

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

References

El-Kadiry, A.EH., Lumbao, C., Salame, N. et al. Bone marrow aspirate concentrate versus platelet-rich plasma for treating knee osteoarthritis: a one-year non-randomized retrospective comparative study. BMC Musculoskelet Disord 23, 23 (2022). https://doi.org/10.1186/s12891-021-04910-5

 
Hede, Kris, et al. "Combined bone marrow aspirate and platelet-rich plasma for cartilage repair: two-year clinical results." Cartilage 13.1_suppl (2021): 937S-947S.
 
Anz AW, Plummer HA, Cohen A, Everts PA, Andrews JR, Hackel JG. Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 2 Years: A Prospective Randomized Trial. The American Journal of Sports Medicine. 2022;50(3):618-629. doi:10.1177/03635465211072554
 
 
Di Martino A, Boffa A, Andriolo L, et al. Leukocyte-Rich versus Leukocyte-Poor Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis: A Double-Blind Randomized Trial. The American Journal of Sports Medicine. 2022;50(3):609-617. doi:10.1177/03635465211064303
Apr 16, 2021
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Reflect on this podcast and claim Category 1 AMA CME Credit!

Neuromodulation and Headaches-


Dr. Rosenblum discusses a recent review article on Peripheral Neuromodulation and Headaches. Meet Dr. Rosenblum at Upcoming Conferences (ASPN and ASIPP) or schedule a private Ultrasound Course in NY!

 

Upcoming Ultrasound Training Workshop Event-

May 16th, 2021-
Advanced Ultrasound Guided Regional Injections for Emergency Room Doctors-
https://painexam.com/events/us_guided_pain_for_emergency_medicine_physicians/

Resources:
Urits I, Schwartz R, Smoots D, Koop L, Veeravelli S, et al. Peripheral Neuromodulation for the Management of Headache, Anesth Pain Med. 2020 ; 10(6):e110515. doi: 10.5812/aapm.110515.

 

New Updates-

  • ASIPP and ASPN in June and July!
  • Private Ultrasound Courses in NY
  • PainExam Complete- the most comprehensive review in pain medicine, regenerative pain treatments and ultrasound guidance!
  • WAPMU Collaboration- coming soon!

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Download the PainExam Official Apps for Android and IOS Devices!

https://play.google.com/store/apps/details?id=com.painexam.android.painexam&hl=en_US

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Follow PainExam-
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https://www.youtube.com/user/DocRosenblum/videos

 

Feb 11, 2021

David Rosenblum, MD and Tim Deer, MD

March 14th- Virtual Ultrasound Training Courses for Anesthesiologist

April 18th- Live Ultrasound Training course in NYC

See you in Miami at ASPN this July....

Dr. Rosenblum sits down with Tim Deer and discusses work life balance, neuromodulation, pain management training, the American Society of Pain and Neuroscience...

 

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Annual ASPN Conference link:

https://aspnpain.com/annual-conference-2021/
 
March Madness Debate link (we’ll continue to update the page as more information becomes available):
https://aspnpain.com/aspn-march-madness-debates/
 
The Superbowl of Debates link:
https://aspnpain.com/aspn-the-superbowl-of-debates/
 
If desired, the 2021 Call for Poster Abstracts link:
https://aspnpain.com/aspn-call-for-poster-abstracts/
Jan 26, 2021

Dr. Rosenblum interviews Dr. Baxter on her thermo-mechanical neuro-modulatory pain relief platform.

Amy Baxter, MD ER doctor Amy Baxter MD FAAP FACEP is a Clinical Associate Professor in Emergency Medicine at Augusta University and the founder and CEO of Pain Care Labs, the industry leader in noninvasive pain relief solutions. She is an academic, physician and research focused entrepreneur that invented a thermo-mechanical neuro-modulatory pain relief platform. Her patents include VibraCool® Vibrational Cryotherapy to treat tendinopathies and decrease opioid use, and her disruptive Buzzy® device, which has been used to control needle pain for over 37 million needle procedures. Dr. Baxter was awarded over 2.8MM in Fast-Track SBIRs by the NIH.

She also prepared and filed the FDA 510K submission for medical devices, securing the FDA expansion of the utilization to include muscle pain and cosmetic injection pain control. Dr. Baxter and Pain Care Labs were recently honored with the 2020 Tibbetts Award for Innovation for the substantial economic and social benefits the company’s pain-relieving medical devices have contributed to the United States. 

Buzzy for Healthcare, https://shop.paincarelabs.com/collections/healthcare

Buzzy for personal, https://shop.paincarelabs.com/collections/buzzy%C2%AE

VibraCool, https://shop.paincarelabs.com/collections/vibracool-r

Buzzy Pain Management Podcast

Ultrasound Guided Interventional Pain Training

Ultrasound Guided Pain Course- Nerve Blocks, Regional Anesthesia

 

Jan 21, 2021
Dr. Rosenblum preempts his upcoming Ultrasound Guided Interventional Pain Course for Physiatry and Pain Physicians on February 28, 2021 with a Journal club describing the Erector Spinae Plane Block.
 
ESP Block for ER Docs, Regional Anesthesia Course March 14 on line
 

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February 7, 2020
Ultrasound Guided Pain Procedures for Emergency Room Physicians

February 28, 2020
Ultrasound Guided Pain Procedures in the Pain Office

March 14, 2020
Ultrasound Guided Regional Anesthesia for  Anesthesiologists

Private Session
Register on Link (for any day)- Set Day and Time Separately with Dr. Rosenblum
  • 4 Hour CME Webinar Access
  • 2 Hour Hands on (in Person in NY or via Zoom)
  • Tips on Safe Integration into your Practice
  • Billing

 
 
 
 
Reference
 
  1. Krishnan S, Cascella M. Erector Spinae Plane Block. [Updated 2020 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545305/
  2. EnesAydinbEmreSengunaAtifBayramogluaHaci AhmetAlicibHigh-thoracic ultrasound-guided erector spinae plane block for acute herpes zoster pain management in emergency department. The American Journal of Emergency Medicine. Volume 37, Issue 2, February 2019, Pages 375.e1-375.e3ErdalTekinaAliAhiskalioglubMuhammed 

     

Dec 22, 2020

Dr. Rosenblum apologizes on behalf of the Pain Physicians for 2 overlooked topics that could help pain patients...

Neglected topics in Pain Management, diet, nutrition and the cluneal nerves

ultrasound block course calendar

 

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References

Nutritionalfacts.org

Mendonça CR, Noll M, Castro MCR, Silveira EA. Effects of Nutritional Interventions in the Control of Musculoskeletal Pain: An Integrative Review. Nutrients. 2020 Oct 9;12(10):3075. doi: 10.3390/nu12103075. PMID: 33050122; PMCID: PMC7601187.

Nov 27, 2020
 
RSDSA
 
 
 
 
 
 
 
 
 
On this Episode Dr.  Rosenblum:
·         Interviews Jim Broatch, Executive VP and Director: jwbroatch@rsds.org and Beth Seickel bseickel45@gmail.com of the RSDSA
·         Discuss how the Reflex Sympathetic Dystrophy Syndrome Association is making a difference in the lives of Patients and Families affected by CRPS
·         NonProfit activities that the RSDSA has developed
·         Clinician Education and more!
 Walk Images 5.jpg

Sep 25, 2020

Sickle cell disease and pain management

Dr. Rosenblum Discusses:

  • Sickle Cell Disease
  • Crisis
  • Types of Pain associated with Sickle Cell Disease
  • Opiate and non opiate management

Ultrasound Block Course

 

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